Provider Demographics
NPI:1285681544
Name:SPENARD, MICHAEL R (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:SPENARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:150 PRESIDENTIAL WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1100
Mailing Address - Country:US
Mailing Address - Phone:781-782-1300
Mailing Address - Fax:781-782-1350
Practice Address - Street 1:150 PRESIDENTIAL WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1100
Practice Address - Country:US
Practice Address - Phone:781-782-1300
Practice Address - Fax:781-782-1350
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP86411Medicare UPIN
MAAP1921Medicare ID - Type UnspecifiedMEDICARE NUMBER